Acute Rejection of Transplanted Liver

Definition

Immunological reaction to foreign (donor) tissue components, especially bile duct epithelium and endothelium

Usually occurs within first year post-transplant
- Most cases during first six months
Mixed portal inflammatory infiltrate
- Eosinophils frequent and relatively specific
Intraepithelial lymphocytic bile duct infiltrate
- Involves interlobular ducts
- May damage ducts
Venous lymphocytic endotheliitis
- May involve portal or central vein
Lobular inflammation and spotty hepatocyte necrosis uncommon
Central rejection associated with poorer prognosis
- Pericentral inflammation and endotheliitis
- Associated with steroid resistance and evolution to chronic rejection
- Can evolve to veno-occlusive disease
- Called parenchymal rejection by some
Usually considered to be T cell mediated
- Hyperacute rejection is humoral

Neeraja Kambham MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting : May 9, 2007